Saul Sophie A, Ward Patrick A, McNarry Alistair F
St. John's Hospital, Howden West Road, NHS Lothian, Livingston EH54 6PP, UK.
Western General Hospital, Crewe Road South, NHS Lothian, Edinburgh EH4 2XU, UK.
J Pers Med. 2023 Aug 29;13(9):1327. doi: 10.3390/jpm13091327.
Airway management is usually an uncomplicated and safe intervention; however, when problems arise with the primary airway technique, the clinical situation can rapidly deteriorate, resulting in significant patient harm. Videolaryngoscopy has been shown to improve patient outcomes when compared with direct laryngoscopy, including improved first-pass success at tracheal intubation, reduced difficult laryngeal views, reduced oxygen desaturation, reduced airway trauma, and improved recognition of oesophageal intubation. The shared view that videolaryngoscopy affords may also facilitate superior teaching, training, and multidisciplinary team performance. As such, its recommended role in airway management has evolved from occasional use as a rescue device (when direct laryngoscopy fails) to a first-intention technique that should be incorporated into routine clinical practice, and this is reflected in recently updated guidelines from a number of international airway societies. However, currently, overall videolaryngoscopy usage is not commensurate with its now widespread availability. A number of factors exist that may be preventing its full adoption, including perceived financial costs, inadequacy of education and training, challenges in achieving deliverable decontamination processes, concerns over sustainability, fears over "de-skilling" at direct laryngoscopy, and perceived limitations of videolaryngoscopes. This article reviews the most up-to-date evidence supporting videolaryngoscopy, explores its current scope of utilisation (including specialist techniques), the potential barriers preventing its full adoption, and areas for future advancement and research.
气道管理通常是一种简单且安全的干预措施；然而，当主要气道技术出现问题时，临床情况可能会迅速恶化，从而对患者造成严重伤害。与直接喉镜检查相比，视频喉镜检查已被证明能改善患者预后，包括提高气管插管的首次成功率、减少困难喉镜视野、减少氧饱和度下降、减少气道创伤以及提高对食管插管的识别能力。视频喉镜检查提供的共享视野也可能有助于更好的教学、培训和多学科团队协作。因此，其在气道管理中的推荐作用已从偶尔用作救援设备（当直接喉镜检查失败时）演变为应纳入常规临床实践的首选技术，这在一些国际气道协会最近更新的指南中得到了体现。然而，目前视频喉镜检查的总体使用情况与其广泛可得性并不相称。存在一些可能阻碍其全面应用的因素，包括感知到的财务成本、教育和培训不足、实现可交付的去污流程的挑战、对可持续性的担忧、对直接喉镜检查“技能退化”的恐惧以及对视频喉镜检查的感知局限性。本文回顾了支持视频喉镜检查的最新证据，探讨了其当前的应用范围（包括专业技术）、阻碍其全面应用的潜在障碍以及未来发展和研究的领域。
